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General NPI Number Information
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NPI Number | 1144271628
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Entity Type | Individual
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Provider Name | RUPA D TERVO MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 20815 BROADWATER DR
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City | LAND O LAKES
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State | FL
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Zip | 34638-8318
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Country | US
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Telephone | 727-946-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 23110 STATE ROAD 54 STE 167
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City | LUTZ
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State | FL
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Zip | 33549-6933
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Country | US
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Telephone | 727-946-4443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME85349
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License Number State | FL
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